Diagnosis of incomplete Kawasaki disease

Abstract

Several authors suggested that the clinical characteristics of incomplete presentation of Kawasaki disease are similar to those of complete presentation and that the 2 forms of presentation are not separate entities. Based on this suggestion, a diagnosis of incomplete Kawasaki disease in analogy to the findings of complete presentation is reasonable. Currently, the diagnosis of incomplete Kawasaki disease might be made in cases with fewer classical diagnostic criteria and with several compatible clinical, laboratory or echocardiographic findings on the exclusion of other febrile illness. Definition of incomplete presentation in which coronary artery abnormalities are included as a necessary condition, is restrictive and specific. The validity of the diagnostic criteria of incomplete presentation by the American Heart Association should be thoroughly tested in the immediate future.

Echocardiographic evaluation of complete and incomplete Kawasaki disease in terms of coronary and non coronary cardiac involvement

“…Incomplete or atypical Kawasaki disease refers to patients who do not fulfil the classic criteria of at least four of the five findings. 8 In our study 14% (21 out of 150) patients presented with clinical features suggestive of incomplete Kawasaki disease which is comparable with study by Yu JJ et al 9 where prevalence of incomplete presentation was 15% to 36.2% among patients with Kawasaki disease and relatively more children with incomplete presentation reported were in the extremes of the age spectrum (≤1 year old, or ≥5 to nine years old). In our study also 76% of atypical Kawasaki were of extremes of ages.…”

Incomplete Kawasaki Disease with coronary aneurysms in a young infant of 45 days presented as neonatal sepsis

“…Final outcome is poor due to delayed diagnosis and treatment with immunoglobulin [10]. The diagnosis of incomplete Kawasaki disease might be made in cases with fever lasting five or more days and classical diagnostic criteria with several compatible clinical, echocardiographic, or laboratory findings and exclusion of other febrile illness [11,12]. Diagnosis of atypical Kawasaki disease is usually reserved for those patients who have one or more atypical clinical manifestations such as renal impairment, testicular swelling, unilateral peripheral facial nerve palsy, diarrhea, vomiting, abdominal pain, pulmonary nodules and/or infiltrates, pleural effusions, acute surgical abdomen and hemophagocytic syndrome which are not seen in Kawasaki disease [8].…”

Risk of coronary artery involvement in Kawasaki disease

“…The definitions posed by the different authors regarding the incomplete KD form conditions the prevalence of CAD found in the published studies. Sudo et al 5,8 indicated the presence of CAD in an echocardiography as a mandatory criterion for incomplete KD, so 100% of cases of incomplete KD had CAD. Manlhiot et al 5,9 defined incomplete KD as fever for ≥5 days and 2 or 3 of the standard criteria, disregarding echocardiographic findings.…”

“…3,4 Incomplete KD has been related to a greater delay in diagnosis and treatment onset, which, in turn, could result in a higher CAD risk. 5,6 Our objective is to identify risk factors associated with coronary artery disease in patients with complete and incomplete KD.…”